Hot Flashes What are hot flashes?

A hot flash (is a feeling of warmth that spreads over the body that begins, and is most strongly felt, in the head and neck regions. Hot flashes are a common symptom experienced by women prior to, and during the early stages of the menopausal transition. However, not all women approaching the menopause will develop hot flashes. What causes hot flashes? The complex hormonal changes that accompany the aging process, in particular the declining levels of estrogen as a woman approaches menopause, are thought to be the underlying cause of hot flashes. A disorder in thermoregulation (methods the body uses to control and regulate body temperature) is responsible for the sensation of heat, but the exact way in which the changing hormone levels affect thermoregulation is not fully understood. While hot flashes are considered to be a characteristic symptom of the menopausal transition, they can also occur in men, and in circumstances other than the perimenopause in women as a result of certain uncommon medical conditions that affect the process of thermoregulation. For example, the carcinoid syndrome results from a type of endocrine tumor that secretes large amounts of the hormone serotonin and can cause hot flashes. Hot flashes can also develop as a side effect of some medications and can sometimes occur with severe infections or cancers that may be associated with fevers and/or night sweats. What are the symptoms of hot flashes?

Hot flashes are typically brief, lasting from about 30 seconds to a few minutes. Redness of the skin, known as flushing, may accompany hot flashes. Excessive perspiration (sweating) can also occur; when hot flashes occur during sleep they may be accompanied by night sweats.

The timing of the onset of hot flashes in women approaching menopause is variable.

While not all women will experience hot flashes, many normally menstruating women will begin experiencing hot flashes even several years prior to the cessation of menstrual periods. It is impossible to predict if a woman will experience hot flashes, and if she does, when they will begin. About 75% of women experience hot flashes at some point in the menopausal transition.

How are hot flashes diagnosed? Hot flashes are symptom, not a medical condition. Through a thorough medical history, the healthcare practitioner will usually be able to determine whether a woman is having hot flashes. The patient will be asked to describe the hot flashes, including how often and when they occur,

and if there are other associated symptoms. A physical examination together with the medical history can help determine the cause of the hot flashes and direct further testing if necessary. Blood tests may be performed if the diagnosis is unclear, either to measure hormone levels or to look for signs of other conditions (such as infection) that could be responsible for the hot flashes. What is the treatment for hot flashes? There are a variety of treatments for hot flashes such as:

hormone therapy, bioidentical hormone therapy, other drug treatments, complementary and alternative treatments, phytoestrogens, black cohosh, and other alternative therapies.

Some of these have not been proven by clinical studies, nor are they approved by the FDA. Hormone Therapy Traditionally, hot flashes have been treated with either oral or transdermal (patch) forms of estrogen. Hormone therapy (HT), also referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of estrogens alone or a combination of estrogens and progesterone (progestin). All available prescription estrogen medications, whether oral or transdermal; are effective in reducing the frequency of hot flashes and their severity. Research indicates that these medications decrease the frequency of hot flashes by about 80% to 90%. However, long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed. More recently, it has been noted that the negative effects associated with hormone therapy were described in older women who were years beyond menopause, and some researchers have suggested that these negative outcomes might be lessened or prevented if hormone therapy was given to younger women (prior to or around the age of menopause) instead of women years beyond menopause.

The decision in regard to starting or continuing hormone therapy, therefore, is an individual one in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman's own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

Vaginal dryness Definition Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Vaginal dryness is a hallmark sign of vaginal atrophy (atrophic vaginitis) thinning and inflammation of the vaginal walls due to a decline in estrogen. A thin layer of moisture coats your vaginal walls. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But hormonal changes associated with your menstrual cycle, aging, menopause, childbirth and breast-feeding may affect the amount and consistency of this moisture. Symptoms Vaginal dryness may be accompanied by signs and symptoms such as:

Itching or stinging around the vaginal opening and the lower part of the vagina Burning Soreness Pain or light bleeding with intercourse Urinary frequency or urgency Recurrent urinary tract infections

When to see a doctor Vaginal dryness affects many women, although they frequently don't bring up the topic with their doctors. If vaginal dryness affects your lifestyle, in particular your sex life and relationship with your partner, consider making an appointment with your doctor. Living with uncomfortable vaginal dryness doesn't have to be part of getting older. Causes Conditions that contribute to vaginal dryness include those below.

Decreased estrogen levels Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining and an increased risk of urinary tract infection. Estrogen levels can fall for a number of reasons:

Menopause or the transition time before menopause (perimenopause) Childbirth Breast-feeding Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy Surgical removal of your ovaries Immune disorders Cigarette smoking

Medications Some allergy and cold medications contain decongestants that can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness. Sjogren's syndrome In an autoimmune disease called Sjogren's (SHOW-grins) syndrome, your immune system attacks healthy tissue. In addition to causing dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness. Douching The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated. Tests and diagnosis

Diagnosis of vaginal dryness may involve:

Pelvic exam. Your doctor visually inspects your external genitalia, vagina and cervix and inserts gloved fingers into your vagina and rectum to feel (palpate) your pelvic organs for signs of disease. Pap test. Your doctor collects a sample of cervical cells for microscopic examination. He or she may also take a sample of vaginal secretions to check for signs of vaginal inflammation (vaginitis) or to confirm vaginal changes related to estrogen deficiency.

Urine test. If you have associated urinary symptoms, you'll provide a urine sample to be analyzed for urinary conditions.

Treatments and drugs In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than systemic estrogen given orally or by skin patch. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal, especially if a low dose is used. Vaginal estrogen doesn't decrease testosterone levels important for healthy sexual function the same way oral estrogen can. Vaginal estrogen therapy may also reduce the risk of urinary tract infections. Talk with your doctor about what dose and what product is appropriate for you. Vaginal estrogen therapy comes in several forms:

Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it. Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet into your vagina. Your doctor will tell you how often to insert the tablet.

If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest systemic estrogen, along with a progestin if you have not had your uterus removed (hysterectomy). Systemic estrogen can be given as pills, patches, gel or a higher dose estrogen ring. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you. If you have a history of breast, ovarian or cervical cancer, vaginal estrogen therapy may still be an option, but discuss the risks and benefits with your doctor.